Dr. Nickel graduated from Northwestern University in Evanston, Illinois before attending Loyola University School of Dentistry where he received his dental degree on a full Health Professions Military Scholarship. He earned his certificate in Oral and Maxillofacial Surgery at Brooke Army Medical Center in San Antonio, Texas. Dr. Nickel is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Association of Oral and Maxillofacial Surgery. He is board certified by the National Board of Dental Anesthesiology and a Fellow of the American Society of Dental Anesthesiology. He is a member of the American Academy of Osseointegration and President of the Chicago Society of Oral and Maxillofacial Surgeons for 2008-09.
Dr. Nickel participates annually in dental/ medical missions to Mexico, Central and South America where he works with other volunteers to improve the lives of those who have little or no access to dental care. He is a member of several volunteer organizations to include Healing the Children, El Nino Rey (“the child king” ), the Illinois Foundation of Dentistry for the Handicapped, and Cara (“old friend” in Gaelic).
AFTER PLACEMENT OF DENTAL IMPLANTS
These instructions will help you to understand the expected postoperative condition and explain the recommended care while you are healing.
Implants are Titanium fixtures that are placed in the bone to anchor replacement teeth. In general the implant must heal in the bone for a number of months before the replacement teeth can be made.
Implants may be placed as a one or two stage procedure
TWO STAGE PROCEDURE
The implant is covered over by gum tissue, usually with sutures. A second, minor procedure is necessary to uncover the implant and place an abutment.
ONE STAGE PROCEDURE
The abutment is placed on the implant at the time of the implant placement surgery. Sutures are generally not used in one stage procedures. A metal abutment will be seen protruding from the gum tissue over the implant.
TEMPORARY REPLACEMENT TOOTH (TEETH)
If the implant is replacing a front tooth, usually a temporary tooth appliance is made by the general dentist. This appliance may be worn immediately over the implant site in either a one stage or two stage situation. In one stage placement situations, the appliance may have to be modified to fit over the abutment.
DIET
After implant placement, a liquid, soft diet on the opposite of the mouth is advised. Do not chew directly over the implant for the first week. Also avoid hard food such as nuts or uncooked carrots when chewing on the side of the implant.
SWELLING
After implant placement there may be some swelling of the surgical area and the adjacent facial tissues. The maximum swelling occurs during the first 24 hours after the procedure. It then starts to slowly recede over the next 5 -7 days. To minimize the swelling, place ice packs over the affected area 10 minutes on and 10 minutes off for the rest of the day. It is not necessary to sleep with the ice pack on. After the first 24 hours, it is not necessary to continue the cold application.
It is also recommended that you elevate your head at night and sleep on a few extra pillows. This will decrease some blood flow to you head and neck region and help to limit swelling.
POSTOPERATIVE DISCOMFORT
Patients may experience discomfort in the surgical region after procedures. The pain medicine that was recommended or prescribed should be started as soon as possible, before the local anesthetic wears off. This will allow time for the medicine to be absorbed from the GI tract into the blood stream. Please take the medicine as directed. If you feel that the medicine is not working, please call your doctor for further advice.
INFECTION
After surgical procedures, there is always a chance that an infection might develop. This does not happen in most cases. After procedures that have a higher incidence of post-operative infection, a prescription for antibiotics may be given. Please take this medication as directed until it is finished. Women taking oral contraceptives (birth control pills) please note: penicillin and penicillin-like drugs temporarily decrease the effectiveness of the birth control pills. Other methods of contraception are recommended while taking these antibiotics.
GENERAL CARE AND ORAL HYGIENE
After an implant procedure it is all right to brush your teeth. However please avoid the area around the surgical site for 4-5 days. After 5 days you may brush the abutment, however please avoid using an ultrasonic or mechanical toothbrush on the abutments as the vibration may impair the bone healing to the implant.
Gentle rinsing with water or salt water is recommended. Occasionally a prescription rinse will be recommended. Smoking may impair healing of oral wounds. It is recommended that patients not smoke during the healing period.
WARNING SIGNS
If any of the following should occur, contact us during the day at Northbrook Location Phone Number 847-272-9516, or during the evening or night call Northbrook Location Phone Number847-272-9516 and ask the answering service to page the doctor on call.
- Bleeding which cannot be controlled by biting firmly on gauze for 20 to 30 minutes.
- Pain which is not alleviated by the prescribed dose of medication. Do Not experiment with higher doses.
- Persistent nausea or vomiting.
- An increase in swelling after the first 48 hours, or swelling which interferes with swallowing.
- A very foul-tasting discharge that is unrelieved by normal oral hygiene.
- Temperature greater than 101 degrees Fahrenheit.
ORAL PATHOLOGY
All areas of the body may form pathological conditions; the facial region and the mouth are no different. Examples of some pathological lesions include: ulcers (sores), areas of pigmentation, lumps and bumps of the gums and cheek, and swellings of the jaws.
BIOPSY
Luckily, most of these lesions are benign but may still require further treatment to resolve. Dr. Nickel or Dr. Steinberg may recommend a biopsy in order to be able to tell what is causing the problem. A biopsy is a minor surgical procedure, during which a small sample of tissue is surgically removed. This can usually be done under local anesthesia although some patients may prefer to have some IV sedation. The specimen is then sent to a pathologist, a specialist who looks at the tissue under a microscope to help make a diagnosis. Once the diagnosis is established, treatment can be more specifically directed for that particular entity.
JAW CYSTS AND TUMORS
Some swellings of the jaws are due to cysts and tumors. Cysts are fluid filled sacs of pathologic tissue. Tumors are solid growths. Many of these develop in the jaws from tissue that helped to form the teeth during their developmental stage. Remnants of this tissue can “overgrow” to form cysts and tumors.
DISEASES OF THE ORAL TISSUES
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and pink in color. Any alteration in this appearance could be a warning sign for a pathological process. Many of these are benign, some may be pre-cancerous. The most serious of these is oral cancer. The following can be signs of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
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